6. Lactation
6.1. Influence of lactation on disease activity and
child outcome
Women with IBD are as likely as the general population to breastfeed their infants; the mean duration of the breastfeeding period is shorter than in the general population.196,197 Breastfeeding is not associated with
an increased risk of disease flare and may even provide a protective effect against disease flare in the postpartum year.70,198–201 However, in
one study, lactation was associated with an increase in disease activity; but medication cessation was a relevant confounding factor.202
It is reported that breastfeeding might be protective against the development of early onset of IBD in children.201 Thus, breastfeeding is suggested when possible, as it may have a protective effect against
development of IBD in the offspring; however, the quality of existing data is generally poor. These findings need to be investigated in well-designed prospective studies.
There is also limited evidence that breastfeeding may be associated with a more beneficial gut microbe profile, as it seems to be associated with highest numbers of bifidobacteria and lowest numbers of C. difficile and E. coli,203,204 which may help protect against the development of IBD. Formula milk feeding or breastfeeding do not seem to differ in terms of onset of intestinal inflammation,205 but controversial data exist.206
6.2. Medical treatment during lactation
ECCO Statement 6B
5-ASA derivatives [EL3], thiopurines [EL3], anti-TNFs
[EL4], and corticosteroids [EL4] are of low risk for breast-
fed infants
For a summary of risks of frequent IBD medications used during lactation, see Table 1.
Sulfasalazine is of low risk during breastfeeding. The sulfapyridine moiety is absorbed in minimal amounts and is excreted in milk, but the milk/serum ratio is acceptable.207 This low risk of aminosalicylates has been confirmed in prospective trials.208
Table 1. ECCO overview on drug risk during pregnancy and lacatation.
Drug............... During pregnancy.......During lactation
Mesalazine......Low risk......................Low risk
Sulfasalazine...Low risk......................Low risk
Source: The Second European Evidenced-Based Consensus on Reproduction and Pregnancy in Inflammatory Bowel Disease
ecco-jcc.oxfordjournals.org/content/eccojc/9/2/107.full.pdf